Large picture health warnings on tobacco packs are becoming a global trend, a new Canadian Cancer Society (CCS) report has found.

The report, Cigarette Package Health Warnings: International Status, found there had been tremendous progress internationally in implementing package warnings.

Many countries are increasing warning size, more countries are requiring picture warnings, and an increasing number of countries are calling for up to four or in some cases more rounds of picture warnings.

CCS senior policy analyst Rob Cunningham said international progress had been outstanding.

“There is clearly a strong worldwide trend for countries to use graphic pictures on cigarette packages to show the terrible health effects of smoking,” said Cunningham.

The report provides an overview, ranking 198 countries/jurisdictions based on warning size, and lists those that have finalised requirements for picture warnings. Regional breakdowns are also provided.

Report highlights include:

77 countries/jurisdictions have finalised picture warning requirements, an increase from the 55 that had implemented by the end of 2012. Canada was the first country to implement picture warnings in 2001.

49 percent of the world’s population is covered by the 77 countries/jurisdictions that have finalised picture warning requirements.

Thailand has the largest warnings in the world at 85 percent of the package front and back, surpassing Australia at 82.5 percent (75% front, 90% back). Australia (since 2012) has also implemented plain packaging to prohibit tobacco company colours, logos, and design elements on the brand part of the package. Ireland, the United Kingdom, France and New Zealand are in the process of implementing plain packaging, and the new European Union (EU) Directive provides that the 28 EU countries have the option to implement plain packaging.

60 countries/jurisdictions have required warnings to cover at least 50 percent of the package front and back (on average), up from 47 in 2012, 32 in 2010 and 24 in 2008.

Progress since the last report in 2012 includes: Thailand increasing the size of picture warnings from 55 percent to 85 percent Nepal implementing 75 percent picture warnings, Jamaica improving warnings from 33 percent text to 60 percent pictures, and Uruguay implementing its 7th round of picture warnings (Uruguay’s size is 80%). The new EU Directive will also require picture warnings to cover the top 65 percent of the package front and back, effective 20 May 2016.

Top countries

Below are the top countries in terms of warning size as an average of the front and back.

85% Thailand (85% of front, 90% of back)

82.5% Australia (75%, 90%)

80% Uruguay (80%, 80%)

75% Brunei (75%, 75%)

75% Canada (75%, 75%)

4. 75% Nepal (75%, 75%)

65% Togo (65%, 65%)

65% Turkey (65%, 65%)

65% Turkmenistan (65%, 65%)

65% Mauritius (60%, 70%)

65% Mexico (30%, 100%)

65% Venezuela (30%, 100%)

"The international momentum in implementing picture warnings is all the more impressive given tobacco industry opposition," said Cunningham.

"If picture warnings did not work to reduce smoking, then the tobacco industry would not be opposed. The fact that more than 70 countries and territories have implemented picture health warnings shows that the momentum of this key tobacco control measure has become a powerful force."